Title : Line of defense: How the CPIVCA tool is changing the game in peripheral line care and MRSA bacteremia prevention
Abstract:
Background: Peripheral intravenous (PIV) lines are a critical aspect of patient care in hospitals, but their improper management can lead to complications such as infections, including Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Studies have shown that 46.2% of MRSA bacteremia were associated with the use of PIV. At an inner-city public hospital, there is an increase of hospital-acquired MRSA bacteremia. Prior to the intervention, a hospital-wide audit revealed suboptimal compliance with peripheral line maintenance protocols. By implementing a comprehensive peripheral line audit tool, combined with targeted infection prevention strategies, this study aims to evaluate the impact of these interventions on reducing MRSA bacteremia incidence and improving adherence to best practices for peripheral line care between Quarter 2, 2024 and Quarter 4, 2024. The objective of this study is to assess the effectiveness of a comprehensive peripheral line audit tool and targeted infection prevention strategies in reducing the incidence of hospital-acquired MRSA bacteremia and improving compliance with peripheral line maintenance protocols in an inner-city public hospital.
Methods: A quasi- experiment evaluated hospital acquired MRSA bacteremia from Quarter 1, 2023 to Quarter 1, 2024 as a pre-implementation period (baseline). This data was compared to Quarter 2, 2024 to Quarter 4, 2024, following the introduction of a comprehensive peripheral line compliance audit (CPIVCA) tool. The CPIVCA tool consisted of hospital wide monthly point prevalence assessment of peripheral lines maintenance, just in time education at the time of audit, and reporting findings to leadership for quality, education, follow up, accountability and performance improvement. During the pre-implementation period, the number of hospital-acquired MRSA bacteremia was (13) cases. After the introduction of the CPIVCA tool in Quarter 2, 2024, there was a decrease of hospital-acquired MRSA bacteremia (5) by Quarter 4, 2024. The change in compliance percentage was evaluated using a chi-squared test for statistical significance, resulting in a p-value of 0.01, indicating that the increase in compliance was statistically significant.
Results: The introduction of the CPIVCA tool led to a 22% increase in compliance with peripheral line management protocols, from 35% in Quarter 2, 2024, to 57% by Quarter 4, 2024. This improvement was associated with a significant reduction in MRSA bacteremia rates. Hospital-acquired MRSA bacteremia cases dropped by 88%, from 13 cases to 5. Statistical analysis using a chi-squared test yielded a p-value of 0.01, confirming the statistical significance of these improvements in both compliance and infection rates. The results suggest that the CPIVCA tool effectively improved peripheral line management and contributed to a decrease in MRSA bacteremia infections.
Conclusion: The implementation of CPIVCA tool, along with infection control interventions, significantly improved compliance with peripheral line maintenance protocols and contributed to a reduction in MRSA bacteremia infections at this inner-city public hospital. These results highlight the effectiveness of targeted quality improvement initiatives in reducing hospital-acquired infections and improving patient safety. The success of this intervention emphasizes the need for ongoing audits and staff education to sustain improvements in infection prevention and peripheral line management.
